NPIMap

Organization Active NPI

Common Ground Health Clinic

Doing business as Gretna Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Gretna, LA
National Provider Identifier
1790292845
Registry record updated Dec 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMON GROUND HEALTH CLINIC
Doing business as
Gretna Community Health Center
Practice address
441 Wall Blvd
Gretna, LA 70056-7723
Phone
(504) 361-9800
NPI assigned
Jan 10, 2018
Last updated
Dec 22, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Carleetha Smith
Title
Ceo
Phone
(504) 302-2285

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

441 Wall Blvd
Gretna, LA 70056-7723

Mailing address

441 Wall Blvd
Gretna, LA 70056-7723

Other names 1

  • Gretna Community Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180730000237 LA Part A Provider - Federally Qualified Health Center (FQHC) 9537290226 Practice locations: Gretna, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1790292845. Details of each certification follow.

Federally qualified health center certification: CCN 191000

Legal name
COMMON GROUND HEALTH CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 31, 2018
Last certification
Jul 31, 2018
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 2, 2005 in LA
Enrollment address
441 Wall Blvd
Gretna, LA 70056-7723

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Carleetha Smith Individual Operational/Managerial ControlChief Executive Officer Mar 1, 2018

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1515542400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640131200000",
    "number": "1790292845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "441 WALL BLVD",
            "city": "GRETNA",
            "state": "LA",
            "postal_code": "700567723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "441 WALL BLVD",
            "city": "GRETNA",
            "state": "LA",
            "postal_code": "700567723",
            "telephone_number": "504-361-9800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMON GROUND HEALTH CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-10",
        "last_updated": "2021-12-22",
        "certification_date": "2021-12-22",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "CARLEETHA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "504-302-2285"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gretna Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gretna, LA

Sources for this page

Verify at the official NPI Registry.